The contribution of smallholder agriculture to the nutrition of rural households in a semi-arid environment in South Africa#

The contribution of own food production to the nutrition of households in two neighbouring, rural, semi-arid settlements was investigated. A survey of a 10% probability sample (n=131) of households in Sekuruwe and Ga-Molekane in the Mokgalakwena Local Municipality, Waterberg District Municipality, Limpopo Province, South Africa, conducted in 2001, provided data on household composition, income (cash and kind), poverty status, expenditure and agriculture, including a detailedaccount of the types and quantities of food that were purchased during the month preceding the date of the interview. For each household the food obtained from the different types of agriculture they practised was quantified. Protein, iron and Vitamins A and C were selected as indicators to assess the contribution of purchased and own produced food to the food intake of households. Food composition tables were used to estimate the nutrient content of the different foods. To assess the contribution of irrigated home gardening to food intake of households, Drum & Drip micro-irrigation systems which enabled irrigated vegetable production on an area of 36 m2 were installed on the residential sites of 10 volunteer households in the study area.The results confirmed that income is the most important determinant of household food security in rural South Africa. However, food obtained from various types of dry-land agriculture contributed significantly to household nutrition and without farming the food security of households would be reduced, especially among the ultra-poor. Small-scale irrigated vegetable production was shown to have the potential to substantially raise the amount of the Vitamins A and C available to households but did not address the lack of protein in the diet of ultra-poor households and the lack of iron in the diet of all households

Rapid and Accurate Diagnosis of Pediatric Tuberculosis Disease (RaPaed-TB): A Diagnostic Accuracy Study for Pediatric Tuberculosis.

Introduction: An estimated 1.2 million children develop tuberculosis (TB) every year with 240,000 dying because of missed diagnosis. Existing tools suffer from lack of accuracy and are often unavailable. Here, we describe the scientific and clinical methodology applied in RaPaed-TB, a diagnostic accuracy study. Methods: This prospective diagnostic accuracy study evaluating several candidate tests for TB was set out to recruit 1000 children <15 years with presumptive TB in 5 countries (Malawi, Mozambique, South Africa, Tanzania, India). Assessments at baseline included documentation of TB signs and symptoms, TB history, radiography, tuberculin skin test, HIV testing and spirometry. Respiratory samples for reference standard testing (culture, Xpert Ultra) included sputum (induced/spontaneous) or gastric aspirate, and nasopharyngeal aspirate (if <5 years). For novel tests, blood, urine and stool were collected. All participants were followed up at months 1 and 3, and month 6 if on TB treatment or unwell. The primary endpoint followed NIH-consensus statements on categorization of TB disease status for each participant. The study was approved by the sponsor's and all relevant local ethics committees. As a diagnostic accuracy study for a disease with an imperfect reference standard, RaPaed-TB was designed following a rigorous and complex methodology. This allows for the determination of diagnostic accuracy of novel assays and combination of testing strategies for optimal care for children, including high-risk groups (ie, very young, malnourished, children living with HIV). Being one of the largest of its kind, RaPaed-TB will inform the development of improved diagnostic approaches to increase case detection in pediatric TB

The contribution of smallholder agriculture to the nutrition of rural households in a semi-arid environment in South Africa

The contribution of own food production to the nutrition of households in two neighbouring, rural, semi-arid settlements was investigated. A survey of a 10% probability sample (n=131) of households in Sekuruwe and Ga-Molekane in the Mokgalakwena Local Municipality, Waterberg District Municipality, Limpopo Province, South Africa, conducted in 2001, provided data on household composition, income (cash and kind), poverty status, expenditure and agriculture, including a detailed account of the types and quantities of food that were purchased during the month preceding the date of the interview. For each household the food obtained from the different types of agriculture they practised was quantified. Protein, iron and Vitamins A and C were selected as indicators to assess the contribution of purchased and own produced food to the food intake of households. Food composition tables were used to estimate the nutrient content of the different foods. To assess the contribution of irrigated home gardening to food intake of households, Drum & Drip micro-irrigation systems which enabled irrigated vegetable production on an area of 36 m2 were installed on the residential sites of 10 volunteer households in the study area. The results confirmed that income is the most important determinant of household food security in rural South Africa. However, food obtained from various types of dry-land agriculture contributed significantly to household nutrition and without farming the food security of households would be reduced, especially among the ultra-poor. Small-scale irrigated vegetable production was shown to have the potential to substantially raise the amount of the Vitamins A and C available to households but did not address the lack of protein in the diet of ultra-poor households and the lack of iron in the diet of all households

Tuberculosis Treatment Response Monitoring by the Phenotypic Characterization of <em>MTB</em>-Specific <em>CD4+</em> T-Cells in Relation to HIV Infection Status

HIV infection causes systemic immune activation, impacts TB disease progression and hence may influence the diagnostic usability of Mycobacterium tuberculosis-specific T cell profiling. We investigated changes of activation and maturation markers on MTB-specific CD4+ T-cells after anti-tuberculosis treatment initiation in relation to HIV status and the severity of lung impairment. Thawed peripheral blood mononuclear cells from TB patients with (n = 27) and without HIV (n = 17) were analyzed using an intracellular IFN-γ assay and flow cytometry 2 and 6 months post-TB treatment initiation. H37Rv antigen was superior to the profile MTB-specific CD4+ T-cells phenotype when compared to PPD and ESAT6/CFP10. Regardless of HIV status and the severity of lung impairment, activation markers (CD38, HLA-DR and Ki67) on MTB-specific CD4+ T-cells declined after TB treatment initiation (p MTB-specific T cell phenotype before, during and after treatment completion was similar between people living with and without HIV, as well as between subjects with severe and mild lung impairment. These data suggest that the assessment of activation and maturation markers on MTB-specific CD4+ T-cells can be useful for TB treatment monitoring, regardless of HIV status and the severity of lung disease

Effect of TB Treatment on Neutrophil-Derived Soluble Inflammatory Mediators in TB Patients with and without HIV Coinfection

The mycobacteriological analysis of sputum samples is the gold standard for tuberculosis diagnosis and treatment monitoring. However, sputum production can be challenging after the initiation of TB treatment. As a possible alternative, we therefore investigated the dynamics of neutrophil-derived soluble inflammatory mediators during TB treatment in relation to HIV ART status and the severity of lung impairment. Plasma samples of TB patients with (N = 47) and without HIV (N = 21) were analyzed at baseline, month 2, month 6 (end of TB treatment) and month 12. Plasma levels of MMP-1, MMP-8, MPO and S100A8 markedly decreased over the course of TB treatment and remained at similar levels thereafter. Post-TB treatment initiation, significantly elevated plasma levels of MMP-8 were detected in TB patients living with HIV, especially if they were not receiving ART treatment at baseline. Our data confirm that the plasma levels of neutrophil-based biomarkers can be used as candidate surrogate markers for TB treatment outcome and HIV-infection influenced MMP-8 and S100A8 levels. Future studies to validate our results and to understand the dynamics of neutrophils-based biomarkers post-TB treatment are needed